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      Epidemiology and burden of chronic kidney disease-associated pruritus

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          ABSTRACT

          Chronic kidney disease–associated pruritus (CKD-aP) is a common, yet underrecognized condition in patients with CKD and end-stage kidney disease (ESKD). Real-world observational studies indicate that CKD-aP affects up to 80% of ESKD patients undergoing haemodialysis (HD), with ∼40% experiencing moderate to severe itch. CKD-aP can negatively impact patients’ mental and physical health-related quality of life (HRQoL) and is also associated with sleep disturbance and depression. Several studies have found that CKD-aP is a predictor of adverse medical outcomes, including an increased risk of hospitalizations and mortality. In this article we review the literature relating to the epidemiology of CKD-aP to describe its prevalence across the treatment spectrum of CKD (non-dialysis, HD, peritoneal dialysis and transplant recipients) and to summarize potential risk factors associated with its development. We also review key data from studies that have evaluated the impact of CKD-aP on HRQoL and medical outcomes.

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          Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients.

          S. Maruyama, K Akazawa, Junichiro J. Kazama … (2006)
          Although uremia is well known as the most common cause of pruritus, the mechanisms of pruritus in chronic hemodialysis patients remain unclear. The purpose was to characterize uremic pruritus in more detail and to investigate whether severe pruritus is a marker for poor prognosis. A total of 1773 adult hemodialysis patients were studied. A questionnaire was given to each patient to assess the intensity and frequency, as well as pruritus-related sleep disturbance. We analyzed the relationship between clinical and laboratory data and the severity of pruritus in hemodialysis patients and followed them for 24 months prospectively. In total, 453 patients had severe pruritus with a visual analogue scale (VAS) score more than or equal to 7.0. Among them, more than 70% complained of sleep disturbance, whereas the majority of patients with a VAS score of less than 7.0 had no sleep disturbance. Male gender, high levels of blood urea nitrogen, beta2-microglobulin (beta2MG), hypercalcemia, and hyperphosphatemia were identified as independent risk factors for the development of severe pruritus, whereas a low level of calcium and intact-parathyroid hormone were associated with reduced risk. During the follow-up, 171 (9.64%) patients died. The prognosis of patients with severe pruritus was significantly worse than the others. Moreover, severe pruritus was independently associated with death even after adjusting for other clinical factors including diabetes mellitus, age, beta2MG, and albumin. Severe uremic pruritus caused by multiple factors, not only affects the quality of life but may also be associated with poor outcome in chronic hemodialysis patients.
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            Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.1

            Sepideh Farivar, William E Cunningham, Ron D Hays (2007)
            Background The SF-36 and SF-12 summary scores were derived using an uncorrelated (orthogonal) factor solution. We estimate SF-36 and SF-12 summary scores using a correlated (oblique) physical and mental health factor model. Methods We administered the SF-36 to 7,093 patients who received medical care from an independent association of 48 physician groups in the western United States. Correlated physical health (PCSc) and mental health (MCSc) scores were constructed by multiplying each SF-36 scale z-score by its respective scoring coefficient from the obliquely rotated two factor solution. PCSc-12 and MCSc-12 scores were estimated using an approach similar to the one used to derive the original SF-12 summary scores. Results The estimated correlation between SF-36 PCSc and MCSc scores was 0.62. There were far fewer negative factor scoring coefficients for the oblique factor solution compared to the factor scoring coefficients produced by the standard orthogonal factor solution. Similar results were found for PCSc-12, and MCSc-12 summary scores. Conclusion Correlated physical and mental health summary scores for the SF-36 and SF-12 derived from an obliquely rotated factor solution should be used along with the uncorrelated summary scores. The new scoring algorithm can reduce inconsistent results between the SF-36 scale scores and physical and mental health summary scores reported in some prior studies. (Subscripts C = correlated and UC = uncorrelated)
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              A longitudinal study of uremic pruritus in hemodialysis patients.

              James A Tumlin, Michael J. Germain, Dawn McGuire … (2010)
              Although uremic pruritus (UP) is a highly prevalent complication of chronic kidney disease, it remains poorly characterized. There have been no longitudinal studies of natural history, and no health-related quality of life (HR-QOL) instruments have been developed for UP. The objectives of this study were to describe the natural history of UP, to compare rating scales of itching intensity, and to assess usefulness and validity of HR-QOL instruments for UP. The intensity, severity, and effects of pathologic itching on HR-QOL were assessed prospectively in 103 patients with UP on chronic hemodialysis. Outcome measures were obtained at scheduled intervals over 3.5 months. Itching daily or nearly daily was reported by 84% of patients and had been ongoing for >1 year in 59%. In 83%, pruritus involved large, nondermatomal areas with striking bilateral symmetry. Two thirds of the patients were using medications such as antihistamines, steroids, and various emollients without satisfactory relief of itching. Statistically significant associations were found among itching intensity, severity, and HR-QOL measures in domains such as mood, social relations, and sleep. Among patients with moderate-to-severe UP, changes in itching intensity of 20% or greater were associated with significant reductions in HR-QOL measures. This first longitudinal study of UP describes key features of UP and its effect on HR-QOL. The assessment instruments we have developed are easily used, are responsive to changes in UP intensity, and should facilitate clinical evaluation and research to meet the needs of afflicted patients.
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                Author and article information

                Contributors
                Dana Kim:
                ORCID: https://orcid.org/0000-0003-4611-5770
                Carol Pollock:
                ORCID: https://orcid.org/0000-0001-7167-6495
                Journal
                Journal ID (nlm-ta): Clin Kidney J
                Journal ID (iso-abbrev): Clin Kidney J
                Journal ID (publisher-id): ckj
                Title: Clinical Kidney Journal
                Publisher: Oxford University Press
                ISSN (Print): 2048-8505
                ISSN (Electronic): 2048-8513
                Publication date Collection: December 2021
                Publication date (Electronic): 14 October 2021
                Publication date PMC-release: 14 October 2021
                Volume: 14
                Issue: Suppl 3
                Pages: i1-i7
                Affiliations
                Department of Renal Medicine, Royal North Shore Hospital , Sydney, NSW, Australia
                Department of Renal Medicine, Royal North Shore Hospital , Sydney, NSW, Australia
                School of Medicine, University of Sydney , Sydney, NSW, Australia
                Author notes
                Correspondence to: Carol Pollock; E-mail: carol.pollock@ 123456sydney.edu.au
                Author information
                https://orcid.org/0000-0003-4611-5770
                https://orcid.org/0000-0001-7167-6495
                Article
                Publisher ID: sfab142
                DOI: 10.1093/ckj/sfab142
                PMC ID: 8702817
                PubMed ID: 34987777
                SO-VID: f314503c-9590-4864-9040-e1a086be8acb
                Copyright © © The Author(s) 2021. Published by Oxford University Press on behalf of ERA.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                Date received : 27 May 2021
                Date accepted : 30 July 2021
                Page count
                Pages: 7
                Funding
                Funded by: Vifor Pharma, DOI 10.13039/501100006484;
                Categories
                Subject: CKJ Review
                Subject: AcademicSubjects/MED00340

                ScienceOpen disciplines: Nephrology
                Keywords: chronic kidney disease,end-stage kidney disease,itch,quality of life,uraemic pruritus
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: chronic kidney disease, end-stage kidney disease, itch, quality of life, uraemic pruritus

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